205 Tooth extractions and weight loss in OPSCC 6 Discussion The results of the current study showed that OPSCC patients who underwent tooth extraction(s) prior to IMRT intended to reduce the risk of ORN are more likely to experience significant weight loss of more than 5% during CRT/BRT. Interestingly, the number of teeth extracted and the number of functional units lost did not influence the degree of weight loss and the need for TF. Few researchers studied the effect of dental status on weight loss or nutritional status in head and neck cancer patients. Thereby, uniform methods or widely accepted standardized protocols for dental status assessment are lacking. Despite the use of different study methods and dental status assessment methods, our results are in line with a study published in 2008 suggesting that dental condition, defined by the decayed, missing, and filled teeth index and the masticatory coefficient are risk factors for weight loss at the outset of management of head and neck cancer (HNC) [31]. Another study evaluated dental status by using the Eichner Index in a sample of 104 treatment-naïve HNC patients [32]. These authors reported that a reduced number of functional units was associated with the total nutrition impact symptoms score, but the absence of functional units was not necessarily an absolute impairment to achieve normal dietary intake. In our study, a reduced number of functional units were not associated with weight loss of more than five percent. Limiting factors in previous studies were amongst others a mixture of tumor sites and limited information on possible associative factors. Also, no information was available on tooth loss in the context of pre-treatment tooth extractions or during oncological surgery, and data on weight loss during oncological therapy was underreported as well. Research in the general population has shown a relationship between the number of natural teeth and weight loss. Having fewer teeth or being edentulous increased the risk of clinically relevant weight loss [33-36]. However, this concerns research among elderly people of at least 65 years of age, in which the dental status was examined and not the effect of tooth extractions as an intervention. It remains unclear if the negative effect of tooth extractions on body weight is the result of a decrease in functional units or that it is the result of disrupting the existing masticatory system in its motor-sensory functionality and/or willingness to eat. Previous studies suggested that extractions, masticatory, and swallowing
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